| NPI | 1720285117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: TX R0801) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 002456) |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2022-01-26 |